Provider Demographics
NPI:1356539381
Name:WILSON- REESE, ANJANETTE L (MA CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ANJANETTE
Middle Name:L
Last Name:WILSON- REESE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7880 NW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5055
Mailing Address - Country:US
Mailing Address - Phone:954-288-5012
Mailing Address - Fax:
Practice Address - Street 1:7880 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5055
Practice Address - Country:US
Practice Address - Phone:954-288-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888111100Medicaid